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Propct 10: ) q O n <br /> S11e 'cLgervtclon b ResponstblPltie4 <br /> Site (General) Supervisor Site Health and Safety Officer <br /> Name -�- \lLr Oag. RI ral 0 <br /> Company Title <br /> i <br /> Years With <br /> Com an <br /> Years In <br /> Position <br /> Supervisor's A <br /> Name <br /> Supervisor's <br /> Title 1.1C. OrJ N "P P <br /> Description of fps-SE.S ' A (., toL--r,1.-SAwT4 , sit <br /> Responsibilities p lP -4-Ov'9 OF hmrrA <br /> On-Site EjtGgV 'Vor.- 1 <br /> 0?2- <br /> Description of N N Gw ArwL IF S'TE>v(— <br /> Authority On <br /> Site: )S �T'1{J�ft� Lt, IS N(Yr 'TAEAI``.- <br /> During Routine <br /> Activities <br /> Ouring •INCI�ArK.tc U ' W24UTn y W3TL1c. Wi'tN SrTL SVPiwe <br /> Emergencies <br /> S A i-Tti OFF IG Ar Iva a�.C.�wcLi s <br /> For CiA a /L.£ ov tv. lyo�'�.ItE1�b n P- �Pavu TO �i1L.[.. <br /> Disciplinary <br /> Actions <br /> 5►1*f.. IGQEf-mL4 NESiAsAlwl <br /> Attach Copies of Records/Certificates Demonstrating Compliance With 29 CFR <br /> 1910.120 (HAZWOPER) Training Requirements <br /> Reference: AWnwb County Paqwvmwnt 17(a). 29 CFR 1910.120(bX2) <br />